Truth and Love

One of the biggest problems with the customer service model is that it does not allow us to get to the root of the problems we see.  In the customer service model, the customer is always right, and they get what they paid for.  The reality is, in healthcare, the customer isn't always right.  People seek medical attention because the don't know what the problem is or how to manage it. 

Dr. Thomas A. Doyle wrote a summary of an ER shift in his blog for Emergency Physicians Monthly.  "In a single night I had patients come in for the following complaints (all brought by ambulance):  “Smoked marijuana and got dizzy”, “stung by a bee and it hurts”, “got drunk and have a hangover”, “sat out in the sun and got sunburn”, “ate Mexican food and threw up”, “picked my nose and it bled, but now it stopped”, “just had sex and want to know if I’m pregnant.” We have all had these patients.  He continues in his blog to make the point that these people don't need medical attention, they need to hear the truth that these symptoms will resolve without intervention.  They need to hear that their own actions are often causing the disease. 

This requires us to speak difficult truths to people that they will likely not want to hear.  People need to hear that weighing 250 pounds is likely causing their chronic knee and back pain.  Smoking will probably kill you it will just take some time.  If you drink too much, do drugs, engage in dangerous sexual practices, you are going to get hurt.  And it is true that behaving like you are in desperate need of narcotics often means you have a drug addiction problem.  Just because we invented illnesses like fibromyalgia doesn't mean it's real and it isn't an excuse to put everybody with depression on narcotics.  And no, vicodin isn't necessary for every dental pain, sprained ankle, and neck strain.

We have to be able to speak truth.  Truth is hard to hear.  As clinicians we have to speak this truth in love.  Being an asshole to someone who is obese, addicted, or one nugget short of a happy meal doesn't help.  We have to treat people with respect, compassion, and kindness.  Truth without love is more like a vendetta. Truth is not a license to vomit anger and frustration on someone else.  Healthcare providers need to frequently examine their own mental health to ensure we approach patients in the right attitude.

One the other hand, being loving without being truthful enables bad behavior.  Every addict has a co-dependent enabler helping them along.  When the customer services model of healthcare demands clinicians to give the consumer what they want, we are pressured to order CT scans when they aren't needed, obtain blood tests and give narcotics when we know the harm of these interventions will outweigh any benefit.  We have become the enabler.  

When we see medicine as ministry the goal of healthcare changes.  The goal is to help people be healthy and whole physically, spiritually, and mentally.  In order to be whole, we often have to do difficult things.  We have to say difficult things.  We have to confront our inner demons, start exercising, and go to a therapist.  We need the freedom as clinicians to talk about what people need, not what they want.  This may mean we have unhappy customers.  But what we're really after is healthy humans.